Ankylosing Spondylitis Disease Activity Research Articles

Effect of HLA-B27 status and body mass index on the clinical response to infliximab in ankylosing spondylitis patients

Background: Tumor necrosis factor-alpha inhibitors (infliximab) have changed the therapeutic approach to ankylosing spondylitis (AS). Body mass index (BMI) and HLA-B27 status may affect the response to infliximab. Methods: One hundred and seventy AS patients with active disease were enrolled in the study. Age, sex, disease duration, HLA-B27 status, and other demographics were obtained. Patients were classified according to their BMI to three groups clinical response was monitored using Bath AS disease activity index, at the time of initiation of treatment and 6 months later. Clinical response was defined as BASDAI50. Results: At baseline, all the groups were comparable. The median BMI of the responders was 25.4 kg/m2 while for the nonresponders it was 27 kg/m2. The normal weight and overweight AS patients have achieved the BASDAI 50 response after 6 months of infliximab treatment (P Conclusion: Obese AS patients are less likely to achieve a response to infliximab than normal weight AS patients.

Characterization of ankylosing spondylitis in Upper Egypt

Objective: To explore the features of ankylosing spondylitis (AS) in Upper Egypt which has been under estimated in this area known for its lower socioeconomic status (SES). Methods: Seventy patients with a definite diagnosis of AS were prospectively evaluated. Information about human leukocyte antigen (HLA-B27) status, pattern of axial and peripheral involvement, inflammatory markers, extra axial features and axial radiographic findings together with other demographic variables were recorded. Bath AS disease activity and functional status (BASDAI and BASFI) were also assessed. Results: The mean age at onset was 24.9 ± 7.5 years and at diagnosis was 35.46 ± 12.1 years, with a diagnostic delay of 9.9 years on average. The male to female ratio was 2.9:1. HLA-B27 was positive in 38 of 51 patients (74.5%). Eighteen patients (25.7%) had a family history of AS. Peripheral arthritis was present in 14 patients (20%). Anterior uveitis was present in 5 patients (7.1%). The mean radiographic sacroiliitis grade was 2.42 ± 0.59. Lumbar syndesmophytes were present in 45 patients (64.3%) and bamboo spine was present in 13 (18.6%). Thirty (42.9%) patients had radiographic hip abnormalities, of whom 6 had received hip replacement surgery. Of 65 patients examined by bone densitometry, osteoporosis was diagnosed in 26 patients (40%). The mean BASDIA and BASFI were 4.8 ± 1.18 and 5.4 ± 1.5, respectively. Axial radiographic damage was significantly greater in men (P >0.001). Only 6 patients (8.6%) were aware of the nature of the disease and were maintained on regular treatment. Conclusion: The characteristics of AS in Upper Egypt were revealed. Noticeable radiographic damage with a high BASFI and BASDAI indicated a more severe disease than that reported in other Middle Eastern populations with a higher SES.

Gender differences in ankylosing spondylitis patients: Relation to clinical characteristics, functional status and disease activity

Objective: To assess gender differences in Ankylosing Spondylitis (AS) patients regarding the clinical presentation, disease activity and functional status. Methods and findings: Forty AS patients; 21 males and 19 females, regularly following at the Rheumatology outpatient’s clinic, Saudi German Hospital, Riyadh, KSA were included. Functional status and the disease activity were evaluated using Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath AS Disease Activity Index (BASDAI) respectively. Mean age was 34.3 ± 8.5 years with a comparable sex ratio (M:F 1.11:1). Morning stiffness was markedly lower in females (72.4 ± 52.4 vs 112.9 ± 44.4 minutes) (p=0.01).Bilateral sacroiliitis was significantly more in males (n=18; 85.7% vs n=13; 68.4%) (p=0.02).The Schöber’s test was more limited and the finger-to-floor distance more increased in males (4.5 ± 0.8 cm and 40.7 ± 9.2 cm vs 4.9 ± 0.7 cm and 27.9 ± 9.7 cm; p=0.046 and p<0.001 respectively). Human leukocytic antigen-B27) was positive in 85.7% of males while rheumatoid factor was positive in only 3 females. BASFI showed significantly higher value in females (6.7 ± 1.1 vs 5.8 ± 1.4) (p=0.04), while BASDAI showed only a tendency to be higher in females. Using Magnetic resonance imaging of the sacroiliac joint, sacroiliitis was detected in all cases with signs of activity in 9 males and 7 females, erosions in 8 males and 5 females, effusion in 1 female and total ankylosis in 1 male. Conclusion: The clinical presentation and genetic background were more remarkable in the AS males; however the disease activity and functional impairment were increased in females. Radiological findings were comparable.Understanding the gender differences in AS may discern how this may impact future research, diagnosis and treatment.

The impact of osteoporosis in patients with ankylosing spondylitis and its relationship to physical activity

Background: Osteoporosis (OP) is a major fracture risk in ankylosing spondylitis (AS), and there are few qualitative reports on bone mass in AS. Objective: The aim of this study was to correlate the bone mineral density (BMD) with disease activity and physical activity (PA) in AS. Materials and Methods: Sixty-two participants who met the criteria for diagnosis of AS (28 males and 34 females) were recruited from Al-Yarmouk Teaching Hospital Baghdad, Iraq. The study was conducted at baseline and after 6 months of exercises. European health-related quality of life was used to reflect physical function. The erythrocyte sedimentation rate and C-reactive protein were used to evaluate AS disease as markers for disease activity. The study measured BMD at two events, before and after performing the relevant exercise. Results: Results found that 9.6% of patients reported fractures. Low bone mass in the AS patients were 17 (27%) in number. Osteopenic patients were 9 (14%) in number, while osteoporotic patients were 8 (13%) in number. An association (P = 0.05) between BMD and PA was noticed in AS participants. There was a weak (P

Evaluation of periostin and factors associated with new bone formation in ankylosing spondylitis: Periostin may be associated with the Wnt pathway.

Periostin has been shown to be involved in bone anabolism through the regulation of Wnt-β-catenin signaling. It may be one of the pathogenic mechanisms in syndesmophyte formation in ankylosing spondylitis (AS). The aim of this study was to evaluate serum periostin levels in patients with AS and to assess relationships among biomarkers of bone formation and periostin in disease outcomes, particularly radiographic changes. Ninety-seven consecutive AS patients (78% male) and 48 healthy controls (75% male) were included in the study. Serum periostin, dickkopf-1 (DKK-1), sclerostin and vascular endothelial growth factor (VEGF) levels were measured using commercially available enzyme-linked immunosorbent assay kits. Disease-related characteristics of patients were assessed using Ankylosing spondylitis disease activity score - C-reactive protein (ASDAS-CRP), Bath AS Disease Activity Index, Bath AS Functional Index and Bath AS metrology index. Radiographs were scored using the modified New York criteria and modified Stokes AS spinal score (mSASSS). Compared with control subjects, patients with AS had significantly lower serum levels of periostin (P < 0.001) and sclerostin (P < 0.001), but higher serum levels of VEGF (P < 0.001) and high-sensitivity CRP (P < 0.001). Serum periostin (P = 0.005) and sclerostin levels (P = 0.016) were significantly lower in patients with very high disease activity according to ASDAS-CRP. Current age (P = 0.009), age at symptom onset (P = 0.021) and hip joint involvement (P = 0.012) were independently associated with the development of syndesmophyte, in contrast to biomarkers of bone metabolism that we evaluated. Our results suggest that periostin is down-regulated in AS patients with highly active disease and may contribute to disease pathogenesis through an interaction with Wnt signaling.

I-BET151 inhibits expression of RANKL, OPG, MMP3 and MMP9 in ankylosing spondylitis in vivo and in vitro.

Ankylosing spondylitis (AS) is characterized by osteoclastogenesis and inflammatory bone resorption. The present study aimed to investigate the effect of bromodomain and extra-terminal domain (BET) protein inhibitor I-BET151 on AS process. A total of 38 AS Chinese patients were recruited and a further 38 sex- and age-matched healthy participants were selected as control. The Bath AS Function Index and Bath AS Disease Activity Index were assessed in AS patients and levels of erythrocyte sedimentation rate and C-reactive protein were measured in AS and healthy groups. Serum from AS patients was used to induce MG63 osteoblasts and BET inhibitor I-BET151 at concentrations of 50, 100 and 200 ng/ml used for treatment of the cells. A HLA-B27/β2m transgenic AS Lewis rat model was established and treated with 30 mg/kg I-BET151 for 5 weeks. Levels of receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), matrix metalloproteinase (MMP)3, and MMP9 were measured using ELISA in vivo and additionally detected with western blotting and polymerase chain reaction in vitro. The levels of RANKL, OPG, MMP3 and MMP9 were upregulated in AS serum, AS serum treated MG63 cells and HLA-B27/β2m transgenic AS rats. Conversely, levels of RANKL, OPG, MMP3 and MMP9 were significantly inhibited in cells or animals treated with I-BET151. Overall, the results of the present study demonstrated that BET inhibitor I-BET151 suppresses levels of RANKL, OPG, MMP3 and MMP9 in AS in vivo and in vitro. I-BET151 may exhibit the potential to be used as a therapeutic in the treatment of AS patients.

Posttraumatic stress disorder and correlates of disease activity among veterans with ankylosing spondylitis.

The objective of this retrospective study was to evaluate the prevalence of comorbid Posttraumatic stress disorder (PTSD) and the association of PTSD with pain, disease activity, and medication use in ankylosing spondylitis (AS). Veterans with one or more visit to an outpatient rheumatology clinic at a single Veterans Affairs site during a 2-year study period were identified by ICD codes for AS and included if there was documentation of AS diagnosis by a rheumatologist. Data were collected on PTSD diagnosis, demographics, pain scores, disease activity by the Bath AS Disease Activity Index (BASDAI), and medication use. Characteristics were compared by PTSD status using t tests for continuous variables and Chi-square or Fischer's exact test for categorical variables. Of 113 Veterans with AS, 20 (18%) had a diagnosis of PTSD. Those with PTSD were significantly younger, 52±17years, as compared to those without PTSD, 59±14years (p=0.04). BASDAI was recorded for 30% with a mean score of 4.3±2.0. Those with PTSD had higher mean pain and BASDAI scores as compared to those without PTSD (p=0.06 for both comparisons). Prescribed medications were similar for both groups in regards to synthetic disease modifying antirheumatic drugs (DMARDs), biologics, and opioids, although those with PTSD were significantly more likely to receive NSAIDs (p=0.03). Veterans with AS and comorbid PTSD were younger and had higher reported pain and disease activity scores compared to those without PTSD in this single site study. These findings underscore the importance of identifying PTSD in patients with AS.

Factors leading to work absenteeism in Tunisian ankylosing spondylitis patients

BackgroundThe work productivity loss due to ankylosing spondylitis (AS) has a notable socioeconomic impact. Aim of the workTo evaluate the professional characteristics of Tunisian AS patients and determine conditions that lead to absenteeism. Patients and methods99 AS patients were included. Disease characteristics and specific AS indices were assessed; Bath AS disease activity index (BASDAI), Bath AS disease functional index (BASFI), Bath AS disease global index (BASG-s), Bath AS radiologic index (BASRI), hospital anxiety and depression (HAD) scale and Shorts Form-36 (SF-36). Visual analogue scale was used to evaluate pain and fatigue. Patients were questioned on their work situation, work sector, work conditions (rhythm, posture, working hours, distance to workplace, duration of rest) and whether they have missed work time during the last three months because of their disease. ResultsMean age of patients was 40.02±11.78years; 70 men and 29 women. The mean disease duration was 11.87±10.7years. Absenteeism was present in 23.2% of the cases. Only the deterioration of the mental component of the SF-36 was associated with absenteeism (p=0.03). Depression and anxiety states seemed not to increase absenteeism, gender and work sector had no influence. Factors significantly associated with absenteeism were increased working hours (p=0.037), bad posture (p=0.001), stress at work (p=0.035) and insufficient day rest duration (p=0.007). Carrying heavy loads tended to be more frequent in the absenteeism group (p=0.08). ConclusionAbsenteeism is high amongst Tunisian AS patients. Work conditions were important factors of absenteeism in Tunisian AS patients that directly influence productivity.

Cross-cultural adaptation and validation of the Chinese version of the Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S).

The Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) is a commonly used questionnaire to evaluate function and health status of patients with ankylosing spondylitis (AS). The objective of this study was to cross-culturally adapt the HAQ-S into Chinese and then to evaluate its reliability and validity. The Chinese version of the HAQ-S was obtained with a five-step procedure of translation and cross-cultural adaptation. All invited patients met the New York criteria for AS, and a total of 103 patients finally participated in this study. Intraclass correlation coefficient (ICC) was used to evaluate the test-retest and inter-rater reliability of the HAQ-S. Internal consistency of the questionnaire was evaluated by Cronbach's alpha coefficient. Spearman's correlation coefficient was calculated to assess the construct validity between the HAQ-S and Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), and the laboratory parameters (erythrocyte sedimentation rate, ESR; C-reactive protein, CRP). Test-retest and inter-rater reliability were excellent with intraclass correlation coefficients of 0.987 (p<0.05) and 0.982 (p<0.05), respectively. The overall internal consistency of the HAQ-S was found satisfactory (Cronbach's alpha=0.914). The Chinese version of the HAQ-S correlated good with the BASFI (r=0.749, p<0.01), and moderate with the BASDAI (r=0.581, p<0.01) and the BASMI (r=0.425, p<0.01). But, the adapted questionnaire correlated poorly with ESR (r=0.298, p<0.01) or CRP (r=0.283, p<0.01). The Chinese version of the HAQ-S is reliable and valid for the evaluation of Chinese-speaking patients with AS.

Role of Diffusion-weighted and Contrast-enhanced Magnetic Resonance Imaging in Differentiating Activity of Ankylosing Spondylitis.

Background:Previous studies showed that combining apparent diffusion coefficient (ADC) value with the Spondyloarthritis Research Consortium of Canada (SPARCC) index value might provide a reliable evaluation of the activity of ankylosing spondylitis (AS), and that contrast-enhanced (CE) magnetic resonance imaging (MRI) is unnecessary. However, the results were based on confirming only a small random sample. This study aimed to assess the role of CE-MRI in differentiating the disease activity of AS by comparing ADC value with a large sample.Methods:A total of 115 patients with AS were enrolled in accordance with Bath AS Disease Activity Index and laboratory indices, and 115 patients were divided into two groups, including active group (n = 69) and inactive group (n = 46). SPARCC, ΔSI, and ADC values were obtained from the short tau inversion recovery (STIR), diffusion-weighted imaging (DWI), and CE-MRI, respectively. One-way analysis of variance and receiver operating characteristic analysis were performed for all parameters.Results:The optimal cutoff values (with sensitivity, specificity, respective area under the curve, positive likelihood ratio, and negative likelihood ratio) for the differentiation between active and inactive groups are as follows: SPARCC = 6 (72.06%, 82.61%, 0.836, 4.14, 0.34); ΔSI (%) = 153 (80.6%, 84.78%, 0.819, 5.3, 0.23); ADC value = 1.15 × 10−3 mm2/s (72.73%, 81.82%, 0.786, 4, 0.33). No statistical differences were found among the predictive values of SPARCC, ΔSI, and ADC. Multivariate analysis showed no significant difference between the combination of SPARCC and ADC values with and without ΔSI.Conclusions:Using large sample, we concluded that the combination of STIR and DWI would play significant roles in assessing the disease activity, and CE-MRI sequence is not routinely used in imaging of AS to avoid renal fibrosis and aggravation of kidney disease.

Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-α therapy on sleep problems: A polisomnographic study.

This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor α (anti-TNF-α) therapy on sleep disorders. A total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n=15) with high DA and receiving anti-TNF-α therapy, and Group II (n=19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF-α therapy in Group I. Baseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF-α therapy, PSQI and snoring score were significantly higher in Group I (P=0.0001, P=0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P=0.005) at the third month of anti-TNF-α therapy, no change was observed in PSG parameters (P>0.05). Sleep disorders increase in AS, particularly in patients with high DA. Anti-TNF-α therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.

The relationship between disease activity, quality of life, and personality types in rheumatoid arthritis and ankylosing spondylitis patients

We hypothesized that clinical outcomes might be influenced by personality type (A, B, C, D) in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). One hundred ninety-four patients (104 with RA, 90 with AS) participated in a questionnaire study. We evaluated health-related quality of life (HRQoL) using the Medical Outcome Study Short-Form 36 (SF-36), personality type A/B with the Jenkins Activity Survey, type C with the State-Trait Anger Expression Inventory Anger-in Scale, type D with the Type D Personality Scale, and disease activity with Disease Activity Score with 28 joints for RA and Bath Ankylosing Spondylitis Disease Activity Index for AS. We used Pearson's correlation coefficient, independent samples t tests, and multivariate analyses of variance. In the RA group, type D personality was significantly correlated with 7/12 SF-36 components. AS patients with type D personality had deficits in all SF-36 subscales. Type D was related with higher disease activity in RA and AS. Both RA and AS type C patients had more active disease forms and negatively affected HRQoL subscales. In the RA group, type A personality did not correlate with HRQoL, but it positively influenced pain visual analog scale scores. In AS patients, type A personality was linked with higher HRQoL and with less active disease. Type C and type D personality types were correlated with decreased HRQoL and higher disease activity in RA and AS patients. Type A personality was associated with less active disease and higher HRQoL in AS patients and with less pain in RA patients.

Correlation of serum MMP3 and other biomarkers with clinical outcomes in patients with ankylosing spondylitis: a pilot study.

The studies aimed to assess a set of biomarkers for their correlations with disease activity/severity of patients with ankylosing spondylitis (AS). A total of 24 AS patients were treated with etanercept and prospectively followed for 12weeks. Serum levels of TNF-α, IFN-γ, TGF-β, IL6, IL15, IL17, MMP3, and MICA were measured at baseline and after treatment. The change of these biomarkers was analyzed for correlations with MRI indices for joint inflammation, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, AS Disease Activity Score, serum CRP, and ESR. The Wilcoxon rank sum test was used to compare the biomarker levels between pre- and post-treatment and between pre-treatment and controls. Both step-wise procedures based on the Akaike information criterion (AIC) and least absolute shrinkage and selection operator with fivefold cross-validation were used to select the best model for pairwise correlations between the above clinical measures and the serum biomarkers. Serum levels of both MMP3 and IL6 were significantly higher in AS patients at baseline. After treatment, the levels of MMP3 decreased, but TGF-β and TNF-α increased significantly. The changes of serum MMP3 and MICA were significantly associated with MRI sacroiliac joint (SIJ) scores. CRP was positively correlated with serum MMP3 and IL6. The pattern of combined changes of serum MICA, MMP3, TGF-β, IL17, TNF-α, and IFN-γ predicted the MRI score of SIJ by logistic regression analysis. Specific serum biomarkers were significantly associated with clinical measures of AS. Most prominently, serum MMP3 level was found to have a positive correlation with the MRI score of SIJ and CRP. Serum MICA level negatively correlated with disease remission.

ASSOCIATION BETWEEN ANKYLOSING SPONDYLITIS AND CHRONIC PERIODONTITIS IN DUHOK: A CASE-CONTROL STUDY

Background and objectives: Ankylosing spondylitis (AS) and periodontal disease (PD) are characterized by dysregulation of the host inflammatory response, resulting in soft and hard connective tissue destruction. AS has been related toother inflammatory diseases, however, there is a paucity of data on whether AS is associated with inflammatory PD. The aim of this study to investigate the possible association between AS and chronic periodontitis.Methods: The case-control study included 90 individuals,45 documented patients with AS and had been diagnosed by rheumatologists in the specialized center of rheumatic disease and medical rehabilitation and referred to the department of periodontics, College of Dentistry, University of Duhok and another 45 clinically healthy individuals with PD as a control group. Among studied individuals, 65 were males and 25 were female. A detailed periodontal examination was performed in all subjects, included probing pocket depth, epithelial insertion level (clinical attachment loss) and plaque index and a form of questionnaires was filled from the patients included gender, age, duration of AS disease, medication, risk factors of PD like smoking and level of education.Results : No significant differences were found in two studied groups based on age groups, level of education, smoking, duration of disease and the type of used drugs, but a significant difference was found between two groups based on gender in which AS was more common among males than females.Conclusions: These results suggest that an association may exist between AS and periodontal disease. Such an association would be important since knowledge of an effect of periodontal treatment on AS disease activity or vice versa would lead to the need for close collaboration between rheumatologists and dentists when treating these diseases

Single nucleotide polymorphisms of ABCB1 gene and response to etanercept treatment in patients with ankylosing spondylitis in a Chinese Han population.

Background:Etanercept was highly recommended for patients with ankylosing spondylitis (AS), as its efficacy has been confirmed in AS, while genetic polymorphisms, by affecting drug metabolism or drug receptor, lead to interindividual variability in drug disposition and efficacy. Therefore, this study aims to investigate whether ABCB1 gene polymorphisms can predict therapeutic response to etanercept in patients with AS.Methods:A total of 185 patients with AS in our hospital were recruited into our study from December 2012 to May 2015. The frequency distributions of genotype and allele of rs2032582, rs1128503, and rs1045642 were detected by polymerase chain reaction (PCR) and electrophoresis verification enzyme products method. AS patients received etanercept treatment for 12 weeks, followed by this would be evaluated by the bath AS disease activity index (BASDAI) score improvement and the assessment of spondyloArthritis international society 20/50/70 (ASAS20/50/70) score improvements to explore the relationship between genotype of ABCB1 gene polymorphisms and therapeutic response to etanercept in patients with AS.Results:After 12 weeks, the BASDAI score mean improvement value of rs2032582 A/A genotype was 2.87 ± 0.52. The ratios of patients with rs2032582 A/A genotype reaching the BASDAI50 and ASAS20 evaluation criteria were 64.29% and 92.86%, respectively. The results indicated that efficacy of etanercept was promoted in rs2032582 A/A genotype. The BASDAI score mean improvement value of rs1128503 C/C genotype was 2.79 ± 0.54 after 12 weeks. The ratios of patients with rs1128503 C/C genotype reaching the BASDAI50 and ASAS20 evaluation criteria were 66.67% and 93.94%, respectively. The results indicated that efficacy of etanercept was promoted in rs1128503 C/C genotype. However, no significant associations were observed between rs1045642 and therapeutic response to etanercept in AS patients.Conclusion:ABCB1 gene rs2032582 and rs1128503 polymorphisms may be associated with the efficacy of etanercept in AS patients. ABCB1 gene polymorphisms can act as biological indicators of etanercept efficacy.

Effect of anti-tumor necrosis factor alpha therapy on bone health and biomarkers of bone turnover in Indian patients with ankylosing spondylitis

Background: We evaluated the relationship between bone mineral density (BMD) and biomarkers of bone turnover in ankylosing spondylitis (AS) patients treated with anti-tumor necrosis factor alpha (TNF-α) agents. Methods: Fifty-one AS patients were screened, of which 27 were started on anti-TNF therapy in accordance to the assessment of AS guidelines. Detailed assessments of erythrocyte sedimentation ratio (ESR), Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS metrological index (BASMI), AS disease activity score-ESR, and AS quality of life (AsQOL) questionnaire were done at baseline and 6 months. Vitamin D, parathyroid hormone, and osteocalcin were measured along with BMD of the lumbar spine, anteroposterior (AP) and lateral view, and hip. Results: Out of 27 patients, 12 patients had osteoporosis. At 6 months, significant improvements were seen for BASDAI (mean 2.33 ± 1.08, P Conclusion: Anti-TNF-α has a beneficial effect on bone metabolism resulting in improved bone formation.

Assessment of cardiac sympathovagal activity in the patients suffering from ankylosing spondylitis

Background: Ankylosing spondylitis (AS) is an autoimmune disease which leads to the involvement of skeletal, cardiac, nervous tissues, and other systemic diseases. Aims and Objectives: This study was conducted to assess the cardiac sympathovagal responses in the AS patients using Valsalva maneuver (VM) and tilt-table test (TTT). Materials and Methods: A total of 30 AS patients having Bath AS Disease Activity Index of ≥4 were included in this study. The same numbers of age- and sex-matched controls were also selected. The blood pressure (BP) and electrocardiogram were recorded during VM and TTT. The Valsalva ratio and 30:15 ratio were calculated. Results: During VM, there is a statistically significant decrease in the Valsalva ratio in the cases (P < 0.05). After TTT, there is a significant decrease in 30:15 ratio and significant increase in systolic BP (SBP) in the cases (P < 0.05). Conclusion: The Valsalva ratio in the cases is decreased indicating the parasympathetic loss which is further supported by the decrease in 30:15 ratio observed after TTT. The increase in SBP in cases also supports the shifting of sympathovagal balance toward the sympathetic side.

Validity of Simplified Ankylosing Spondylitis Disease Activity Scores (SASDAS) in Indian Ankylosing Spondylitis Patients.

Ankylosing Spondylitis Disease Activity Score (ASDAS) is a complex score for monitoring disease activity in Ankylosing Spondylitis (AS). To develop a simplified version of the ASDAS. Consenting 254 AS patients (modified New York and/or Assessment in Ankylosing Spondylitis 2009 criteria) were recruited. Sociodemographic data and disease characteristics such as Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and AS Quality of Life (ASQoL), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP) were collected. Simplified ASDAS (SASDAS) was calculated as the simple sum of patient global assessment, back pain (BASDAI question no.2), peripheral pain and swelling (BASDAI question no.3), morning stiffness (BASDAI question no.6), and either ESR in mm/hour (for SASDAS-ESR) or CRP in mg/L (for SASDAS-CRP); this sum was divided by 10 to obtain the final score. Most patients (224/254; 88.19%) were males with the median age of 30 years. SASDAS-ESR and SASDAS-CRP showed good correlation with ASDAS-ESR and ASDAS-CRP respectively (r2=0.78 and 0.58 respectively; p-value<0.0001). SASDAS-ESR showed good correlation with CRP (r=0.50) and is fairly correlated with backpain (r=0.19), morning stiffness (r=0.21) and peripheral pain (r=0.21); SASDAS-CRP showed good correlation with BASFI (r=0.32), and ESR (r=0.55) (all p-value<0.0001). Using established ASDAS cut-off values, corresponding cut-off points between 'inactive', 'moderate', 'high', and 'very high' disease activities (with optimum sensitivity and specificity) were 1.83, 2.45 and 4.45 for SASDAS-ESR, and 0.79, 1.50, and 3.26 for SASDAS-CRP. Both the SASDAS scores showed good correlation with BASDAI. SASDAS-ESR and SASDAS-CRP are reliable, easy-to-calculate scores for disease activity assessment in Asian Indian AS patients; which can be used in daily clinical practice.

Relationship between kinesiophobia and pain, quality of life, functional status, disease activity, mobility, and depression in patients with ankylosing spondylitis

Background/aim: Our aim was to investigate the association of kinesiophobia with pain, quality of life, clinical measures, and depression in patients with ankylosing spondylitis (AS). Materials and methods: Patients with AS (n: 163) were enrolled in the study. Kinesiophobia was evaluated with the Tampa Scale of Kinesiophobia (TSK), pain with a visual analog scale (VAS), mobility with Bath Ankylosing Spondylitis Metrology Index (BASMI), disease activity with the Bath AS Disease Activity Index (BASDAI), functional status with the Bath AS Functional Index (BASFI), depression level with Beck's Depression Inventory (BDI), and quality of life with the AS Quality of Life Questionnaire (ASQoL). Besides correlation analysis, outcome measures were compared between patients with (TSK ? 37) and without (TSK < 37) kinesiophobia. Results: Kinesiophobia was found to be common with a percentage of 66.6%. TSK scores were correlated with VAS, BASFI, ASQoL, and BDI scores (r = 0.259, r = 0.294, r = 0.392, and r = 0.398, respectively; P < 0.05 for each). There were no correlations between TSK and the BASDAI and BASMI scores (r = 0.142, r = 0.198, respectively; P > 0.05). Patients with kinesiophobia had more pain and poorer BASFI, ASQoL, and BDI scores than patients without kinesiophobia (P < 0.05).Conclusion: Our study is the first study that investigated the relationship between kinesiophobia and other clinical measures in AS patients. Pain and psychological status have an impact on fear of movement and thus functional status and quality of life.

Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents?

A spectrum of disease extends beyond the rigid confines of ankylosing spondylitis (AS). Axial spondyloarthritis (axSpA) encompasses non-radiographic axSpA (nr-axSpA) in individuals without established radiographic changes but with other clinical/imaging axSpA features and AS in those with definite sacroiliac joint changes on pelvic X-rays. A broad consensus about the management of nr-axSpA is emerging among clinicians, but the evidence base remains open to question. To explore whether nr-axSpA and AS should be treated similarly, we examined the literature on their prevalence, natural history, disease burden, and treatment. There is strong evidence that nr-axSpA and AS are expressions of the same disease. Approximately 10% of patients with nr-axSpA will develop radiographic disease over 2years; after >20years, the figure may exceed 80%. Nr-axSpA patients have lower CRP and less spinal inflammation on MRI than AS patients but similar disease activity, pain, and quality-of-life impairment. Most patients with nr-axSpA manage well with conservative treatment, but a minority has severe disabling symptoms. Anti-TNF therapy has demonstrated similar efficacy and safety in nr-axSpA and AS. Current evidence does not clearly indicate that anti-TNF treatment can inhibit or limit bony progression of AS, the basis of conservative and anti-TNF treatment is control of symptoms and function. For some patients with nr-axSpA, the need for powerful treatments is as great as in some with AS; thus, treatment of axSpA should be consistent across the axSpA spectrum with anti-TNF agents being available, irrespective of radiographic change, according to the same criteria as those applied to AS.